Healthcare Provider Details

I. General information

NPI: 1982643995
Provider Name (Legal Business Name): FEGS REGO PARK MNL HLTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 10/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9745 QUEENS BLVD
REGO PARK NY
11374-2101
US

IV. Provider business mailing address

315 HUDSON ST 9TH FL.
NEW YORK NY
10013-1009
US

V. Phone/Fax

Practice location:
  • Phone: 718-896-9090
  • Fax: 718-830-0724
Mailing address:
  • Phone: 212-366-8007
  • Fax: 212-366-8069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number6287102A
License Number StateNY

VIII. Authorized Official

Name: MS. KRISTIN WOODLOCK
Title or Position: COO
Credential:
Phone: 212-366-8402